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To see or not to see children upon a parent’s request….

February 25, 2013

A parent phones a counselor seeking therapy for a child. What does the counselor do?

Does the counselor go ahead and set an appointment for the child? Does the counselor meet with the parent first? Just what does the counselor do?

If I am the counselor, I advise the parent that I only meet with parents first. Typically both and there would have to be an extraordinary circumstance for me to not meet with both and to be clear, being separated from the other parent is not an extraordinary circumstance.

There are several good reasons I will only see parents first:

  • No child can provide their own developmental history and at times there are clues to present day behavior from the developmental history;
  • The issue giving rise to the child’s behavior may have it’s origins in parental matters. Seeing the parents first provides an opportunity to assess parental issues that may befall the child.
  • Very importantly, counseling is still stigmatizing. To meet with a child, even a willing child, is to put the experience of counseling on their personal life’s resume. For the younger child, that may not be an issue in the moment, but when that child comes to form later intimate relationships, that child may worry about the perception of their childhood counseling experience in the eyes of their intimate partner. So while not necessarily an issue now, it may create issues in that child’s future. We refer to this as an iatrogenic event – an unintended negative consequence of a reasonable treatment. If by working with the parents, relief can be brought for the distress of the child, then not only has treatment been successful, but the risk of that iatrogenic effect has been limited.

There are also good reasons why parents should meet with the counselor before exposure to their child.

  • Firstly, parents must be sure that the intended counselor has appropriate credentials and training;
  • Parents should also see if the counselor’s personal style or personality would go well with that of their child;
  • Again, very importantly, parents must determine if the value base from which the counselor approaches their child’s issue is consistent with their own. By way of example, if you are seeking guidance for your pregnant teen daughter, it may be wise to determine if the counselor is pro choice. The parents’ values could greatly determine their choice of counselor in such a scenario. So too with drug and alcohol counseling. Some counselors will start from a view that supports abstinence with concern to issues underlying drug/alcohol use whereas another counselor may discuss the context of consumption and counsel from a perspective of personal safety first, but not necessarily abstinence. Again, only by the parents asking about a counselor’s approach will they know if the approach is consistent with their values or expectations.

I worry that people (parents and even some counselors) treat counseling as if it were simply benign, if not helpful. This couldn’t be further from the truth. Counseling isn’t necessarily benign – just ask anyone with a previous bad experience.

Counseling carries its own risks. It can inadvertently leave the client with the impact of a stigma; It can reinforce the very inappropriate behaviors for which treatment is sought; If unsuccessful, it can limit the likelihood of a person ever returning for help when it may be much needed.

As counselor’s it behooves us to tread carefully and examine our work so as to not inadvertently bring more harm or a different harm, particularly when it comes to children.

I don’t just tell the doctor to cut out my appendix for a pain in the side. The doctor assess’ first before cutting. Hell, it just may be gas!

Similarly, when a parent calls with concerns for their child, before rushing in and seeing the child first, we too must assess through the parents and then determine if meeting the child is necessary. It is OK to see a child, there just has to be a good reason.

So for me, to see or not to see children upon a parent’s request depends on what we learn after having met the parents. Parents first, child second.

Gary Direnfeld, MSW, RSW

 

From → Uncategorized

6 Comments
  1. I see child and parent together for first visit. Depending on the child’s age I then determine if a parent is required for a few minutes at each subsequent visit. I have asked parents to provide proof that they are the custodial parent , however it is not up to the therapist and there is no legal liability to the counsellor. Good post, thanks!

  2. I would meet with the parents first to get the overview of what are their concerns. Depending on the age of the child I would then meet with the child and parents (ideally just one of them so the child doesn’t feel over-powered) together. But I may want to see the child with a different guardian too (maybe even one that I have selected). If I suspect child abuse then I have to be aware of the potential that one or both parents are involved.

  3. Robin Deethardt permalink

    I find the comments very helpful here, if only mental health counseling were viewed as normal as seeing a medical doctor, and wouldn’t it be wonderful to view counseling in terms of mental health and wellness instead of a stigma in a person’s history. As a therapist I look at my clients as wanting to improve their mental health and wellness, what a healthy step towards whole body health.

  4. It depends on the age of the child and the circumstances. I sometimes see the parent first and sometimes see the parent and child together and then the child alone. Sometimes I continue to see the parent and child together depending on what the issues are. It is important to get written consent from the parent if the child is under age and consent from both parents if they are separated. If the child is of age I also have him or her sign an informed consent,especially in case it becomes a duty to report issue – one never knows.

  5. Very much depends upon many factors, age of child, presenting issues, etc. I specialising in working with eating disorders which thrive on secrecy and deceit. I therefore endeavour not to replicate this in the counselling room, so meetings with the parents without the child knowing what has been discussed seems to go against my ethos. I usually meet with parents and child and discuss everything openly, and then see the child alone, as they are my client and my confidentiality agreement will be with them. I am always open to discussion about the way that I work, however with eating disorders clear boundaries and open communication seems healthy and sits well with me.

  6. This sparks great conversation. I don’t think there is one hardened rule for how to proceed other then to engage in reflexive practice considering all possibilities and the real effects they could have on youth and care givers as Gill and Leslie have alluded to. Certainly at the walk-in counselling clinic we are faced with these considerations often and under extreme time constraint. However how we proceed does not go without scrutiny and consideration of possible real life effects.

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